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PSY240H1 Lecture Notes - Dementia Praecox, Cognitive Behavioral Therapy, System On A Chip

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Psychotic Disorders - Chapter 11 (Lect. 8) November 17, 2009
History of Schizophrenia
-Kraeplin dementia praecox”
He first described symptoms associated with schizophrenia, but didn’t label it
as such
Intellectual deterioration with early onset
-Bleuler schizophrenia
First coined this term in 1908
Means “fragmented thoughts” or “split head” (which may be why people use
schizophrenia synonymously with dissociative identity disorder but
they’re different; dissociative personalities vs. hallucinations)
-Bleuler again- “Group of schizophrenias”
We now know that there are a number of different subtypes of schizophrenia
which can be extremely different (like catatonic vs. disorganized?)
Probably one of the most researched disorders, but the reasons behind the causes and multiple
symptoms are still a mystery
Schizophrenia Diagnosis
Two or more of the following must be present for a significant portion of the time during a
1 month period
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behaviour
- Negative symptoms (lack of motivation, for example)
Only one symptom is required in certain circumstances (bizarre delusions so bizarre
that they can’t possibly be true or hallucinations; multiple voices different from normal
internal thought processes; conversing; running commentary one voice and
commenting on what one’s doing)
Must cause significant dysfunction
Must last more than 6 months (acute symptoms + residual symptoms)
Though not necessarily active throughout that period of time; just needs to add
up to 6 months
Stuff about Schizophrenia
Affects about 1% of the population (Twice as common anorexia, less common
than bipolar)
Happens at age 15-24 in males, and 25-34 in females
Women seem to have a slightly better of a prognosis (maybe because it develops later, so
they have more skills to work through the symptoms, or women experience fewer
cognitive dysfunctions as a result of schizophrenia)
Very high suicide rate (~10%) strongly correlated to (negative) auditory hallucinations
Very common; ~8% of all hospital beds in Canada are for schizophrenic patients

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Positive Symptoms
Excess or distortion of normal functions (positive =/= good) and are usually present in the
early stages of schizophrenia
Two dimensions:
- Psychotic delusions and hallucinations
- Disorganized thought/speech, behaviour (like catatonic)
Distortions in thought content (perceiving some info from environment and distorting it in
some way that is considered delusional incorrect but very strongly held despite
evidence to the contrary usually relates to some misperception of their experiences)
Bizarre (clearly implausible) vs. non-bizarre (far-fetched but still possible)
- Persecutory (non-bizarre; believing that one is being spied on or persecuted or
targeted, etc.)
Belief is on a spectrum, but the idea still must be firmly fixed
People around them are more aware of the delusions since they may be
accused by the delusional people
Many different patterns; do they accuse a lot of different people or just one?
-Referential (non-bizarre; seeing yourself as a point of reference: for example, thinking
that the environment, insignificant gestures of others, or random sounds are messages
that are directed specifically at you like a newscaster is right in the living room and
talking only to you)
-Grandiose (non-bizarre; having grand ideas like: you believe you’re Jesus, you have
special powers or you’ll be the next president)
Often overlaps with manic episodes (ones who have a manic episode may
have grandiose delusions)
-Somatic (non-bizarre; the false belief that something in one’s body is abnormal,
changed, diseased, etc.)
-Being controlled (bizarre beliefs such as “thought withdrawal,” where one believes that
someone else is taking thoughts/ideas out of one’s mind; or “thought insertion”; or
“thought broadcastingwhere one believes that their thoughts are removed from their
head and broadcasted to everyone else)
Usually have an external trigger (distortion of perceptions)
View all these in the context of religion or culture; for EX. in some Indian cultures, its a
positive thing to get auditory hallucinations
-Distortions in perception (of environment)
-May occur in any sensory modality:
- Auditory
Auditory hallucinations [if they take the form of voices, it is quite distinct from
their own internal voice] are the most common, but in theory, any sensory
modality may occur
Sometimes voices instruct them to do things [like negative things; command
hallucinations big risk factor for chances of suicide]
- Visual
visual hallucinations… pretty self explanatory
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